PhD Candidate in Economics| Vanderbilt University

Research

Near-elderly individuals, those 60 to 64 years old, have high health care needs and, if uninsured, often delay costly care until they enroll in Medicare (Card et al. (2008), McWilliams, et al. (2009)). The passage of the Affordable Care Act (ACA) in 2014 provided new coverage options to uninsured near-elderly individuals. Although understanding the extent to which the ACA affected the near-elderly is key to future health policy decisions, little focus has been given to the near-elderly. I provide the first assessment of the ACA’s effect on near-elderly insurance coverage using three nationally representative surveys. I replicate and update the findings from Card et al. (2008), then extend the analysis by using a difference-in-regression discontinuity design to quantify the effect of the ACA on insurance rates just prior to individuals transitioning into Medicare. I find that the gap in insurance coverage rates between 64- and 65-year olds declines by almost half, from 8 to 4.5 percentage points, after the ACA went into effect in 2014. Consistent with these changes being attributable to the ACA, I also find that most coverage gains come from Medicaid in states that expanded Medicaid eligibility, while coverage gains in non-Medicaid-expansion states come from the kinds of insurance plans available on the exchanges. These results raise questions about the extent to which increasing coverage for the near-elderly may ease demand upon their entry into Medicare and the consequences of an ACA repeal on their access to health care.